The objective of this award is to allow me to obtain the training, mentoring, and experience necessary to become an independent health services researcher in patient safety and informatics. My ultimate goal is to develop a career as an academic leader, using multidisciplinary science to improve the quality of health care related to electronic health record (EHR)-based communication. To accomplish this, I will seek to develop and sharpen a skill set essential to working as a patient safety and informatics health services researcher. I will use the protected time provided by this award to gain training and experience in three principal areas: techniques to evaluate workflow processes, qualitative research methodologies, and human factors principles. Delays in diagnosis and treatment from breakdowns in communication between providers are a common problem in health care and contribute to adverse patient outcomes and malpractice litigation. The importance of identifying strategies to prevent such delays has been highlighted in a recent Agency for Healthcare Research & Quality Special Emphasis Notice (NOT-HS-13-009). I will build on a foundation of work by our team revealing that despite providers' increased use of electronic health record (EHR)-based tools to manage communication, these delays persist. Multiple factors are believed to contribute to such delays, but three are frequent, well-studied, and serve as ideal targets for intervention. These include information overload from large numbers of messages transmitted to providers, lack of EHR-based communication tools that promote situational awareness, and poor ease of use of existing electronic communication tools, which leads to inefficiencies in message processing. In the research proposed, I will use multidisciplinary approach to evaluate electronic communication tools. Specifically, I will evaluate the processes used by providers to manage electronic messages and identify factors that impact communication efficiency and breakdowns. I will then use this information to develop and test a prototype tool that improves processing efficiency, situational awareness, and ease of use. The specific aims of this project are: Aim 1: Evaluate provider asynchronous electronic communication management processes in order to identify facilitators and barriers of provider efficiency and situational awareness. Aim 2: Develop an asynchronous electronic communication prototype tool that optimizes provider efficiency, situational awareness, and ease of use. Aim 3: Evaluate the efficiency, situational awareness, and ease of use of the prototype tool in a simulated environment. Two highly-qualified mentors with substantial experience in patient safety and informatics research will supervise training, which will include mentored research, formal coursework, directed readings, and seminars. The proposed activities will provide a foundation for electronic communication tool designs that improve situational awareness, efficiency, and ease of use. This will reduce delays in diagnosis from communication breakdowns and reduce provider EHR message processing burden, allowing more time for direct patient care.